For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) The RN Senior Clinical Analyst is responsible for clinical and data review associated with United Healthcare Premium Designation Program. The selected candidate will work closely with Clinical Consultant Lead, Medical Director, Project Manager and Data Analytic staff to support United Healthcare Premium Designation Program in order to meet quality, efficiency and utilization goals associated with the program. Primary Responsibilities:Analyze data for possible data integrity and data deficits Collaborate with Clinical Consultant Lead, Medical Director and Data Analytics to provide analytical interpretation of United Healthcare Premium Designation program Perform literature and guideline reviews for current and proposed measures in United Healthcare Premium Designation Participate and assist in preparation of documentation for NCQA audit of provider program Performs all other related duties as assigned
Required Qualifications: Undergraduate degree or equivalent experience (6 years of nursing experience in lieu of degree) Unrestricted Registered Nurse license in state of residence 3 years clinical nursing experience 1+ years of experience with HEDIS / STARS / premium provider programs or quality improvement 3 + years of experience in health care industry Intermediate level of proficiency in software applications that include but not limited to Microsoft Excel; Microsoft PowerPoint; and Microsoft WordPreferred Qualifications:Excellent verbal and written communication skills Strong relationship building skills with clinical and non-clinical personnel Ability to work independently in fast paced environment while adhering to strict business timelines Intermediate proficiency with literature research methods and/or research methodology Experience in data analytics; ETGs; EBMs; PEGs or ERGs Knowledge of basic claims coding including HCPCS; ICD9; ICD10; APR-DRGs; and CPT Ability to analyze problems, draw relevant conclusions and propose an appropriate plan of actionCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: RN, Registered Nurse, Clinical Analyst, Data Analyst, Research Analyst, Medical Claims, Clinical Coding, Telecommute
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.